Introduction to Bowel problems

Going to the toilet to have a bowel movement is something most people take for granted and consider it a very private matter. So when you suddenly experience a problem with your bowels, you can feel rather isolated.

The two most common problems people experience are bowel leakage, when you cannot control when your bowel is open and constipation, where you experience difficulty in moving your bowels.

Learn more about the causes of bowel problems, neurogenic bowel conditions and bowel symptoms.

How common is it to have a bowel problem?

It can be embarrassing to speak out about, which is why many people can go for years without telling anyone about their problem. Because many people never visit their doctor or nurse or reveal their symptoms, the exact number of people affected by bowel problems is unknown. But it is more common than you might think:

  • Studies suggest that approximately 2% of the adult population have daily or weekly bowel leakage episodes

  • The prevalence for adults over 65 years is 7%, and in retirement homes it’s as high as 33%

  • Studies indicate that up to 20% of the population have problems with constipation

Without proper treatment and management, bowel problems can seriously affect quality of life and prevent people from doing the things they enjoy.

What is neurogenic bowel?

Spinal cord

Neurogenic bowel can be described as slow movement of stools, constipation, bowel leakage, and difficulty emptying the bowel. Control of the external anal sphincter muscles may also be disrupted, increasing the risk of bowel accidents

There are two main types of neurogenic bowel dysfunction:

  • Reflex bowel

  • Flaccid bowel


Reflex bowel

Reflex bowel causes loss of the ability to feel when the bowel is full. Although the anal sphincter muscle (the muscle that keeps the anus closed) remains tight, it will open on a reflex basis when the rectum becomes full and, therefore, the bowel can empty at any time unless appropriately managed. Reflex bowel can occur when the spinal cord is damaged above the T12 level.

Flaccid bowel

Flaccid bowel is when the anal sphincter muscle (that normally keeps the anus closed) becomes relaxed and stays open, often leading to accidental emptying of the bowel. Flaccid bowel is generally caused by damage below the T12 level.

One cause of neurogenic bowel is spinal cord injury (SCI). The impact on bowel function depends on the level of spinal cord injury and where the damage occurs (as mentioned above).

Other possible causes of neurogenic bowel include multiple sclerosis, Spina bifida and Parkinson’s disease.

Overflow incontinence

This is a combination of bowel leakage and constipation. You can be constipated but still experience loose stool that leaks past the hard stool.

Typical symptoms of bowel leakage

  • Feeling the urge to have bowel movement but not being able to control when your bowels open, resulting in a bowel accident (urge incontinence)

  • Leaking stools (passive incontinence)

  • Soiling of underwear

  • Being unable to control when you pass air (flatus)

Typical symptoms of constipation

  • Inability to have a bowel movement

  • Bloating

  • Discomfort

  • Severe stomach ache

  • Spending long amounts of time trying to pass stool

Causes of bowel problems

It is important to understand that having bowel problems is not a disease in itself. There is usually an underlying cause as to why your bowels aren’t functioning properly. Common causes of bowel problems can be related to either neurogenic or non-neurogenic disorders.

Non-neurogenic disorders

Bowel problems can also be caused by a number of non-neurogenic conditions including:

Obstetric trauma:
Complications after childbirth, where the sphincter muscles have been damaged leading to the inability to control when you go to the toilet.

Cancer of the colon or rectum:
Cancer of the colon or rectum describes the uncontrolled growth of cells that may cause bowel dysfunction. Some people have an inherited condition called familial polyposis, where large numbers of projecting, swollen and thickened areas of membrane called polyps, which develop on the inner lining of the colon. These polyps can eventually become cancerous.

Anorectal malformation from birth:
Even with surgical correction, you can still experience bowel leakage episodes.

Inflammatory bowel disease:
Inflammatory bowel disease (IBD) is a collection of conditions characterised by inflammation of the large and/or small intestine.

Neurogenic disorders

If you have a neurogenic disorder, you may have neurogenic bowel as it is likely the nerves in your spinal cord, controlling bowel function, are damaged. Some neurogenic conditions causing bowel problems include:

Bowel symptoms

Bowel symptoms can vary depending on the underlying cause. The most common bowel problems people experience are:

Bowel leakage

Bowel leakage is the involuntary passage of stool e.g. you cannot control when your bowel opens, often resulting in bowel accidents.


There is no exact science to what constitutes constipation as the symptoms vary from person to person. It is often characterised by decreased bowel movements and straining at defecation.

When to get in contact with your Healthcare Professional

A lot of people who experience bowel problems may be reluctant to go and talk to their healthcare professional, as bowel problems are very personal and potentially embarrassing subject. It is important to go and seek help, otherwise you may find that your bowel problems start to encroach on daily life.


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